Temporomandibular Disorder

TMD

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This leaflet has been produced to provide you with informationabout Temporomandibular Disorder (TMD) and aims to answerany questions that you may have. If you require any furtherinformation please do not hesitate to ask the dental and nursingstaff caring for you.

What is TMD?

TMD describes a variety of conditions which affect the jaw jointsand muscles. Problems may occur on one or both sides. It is verycommon. Many people have some sign of TMD but only a smallnumber suffer pain.

What causes TMD?

We do not know exactly what causes TMD. For years dentiststhought that TMD was caused by the way the jaws and teethlined up. However, research has shown that mis-alignment ofthe jaws and teeth is not a major cause of TMD. Today webelieve that TMD is caused by many things acting together,some of which may have little or nothing to do with your teeth.Most discomfort is from overuse of the joints and muscles. Thereare many ways this can occur:

• Clenching the teeth together. This may be brought on whenyou are concentrating or extra busy, worried, annoyed oreven by cold winds.

• Grinding the teeth together. This often occurs at night butcan also be during the day.

• Straining the joints and muscles by chewing pencils, bitingnails, holding things in your mouth, holding the telephonebetween your neck and shoulder.

• Overworking the muscles by constant chewing, e.g. chewinggum etc.

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Will it get worse?

TMD does not usually keep getting worse. The problem tends tocome and go, often feeling worse during times of stress. Studiesdemonstrate that it does not get worse with age but is one ofthe few conditions which seem to get better as you get older.

What problems may I experience?

• Jaw pain or soreness that may be worse either on waking orin the evening

• Jaw pain when biting, chewing or yawning

• Clicking from the joint when moving your jaw

• Stiffness or locking of the jaw joint.

• Earache without an infection

• Difficulty opening or closing your mouth

• Frequent headaches

How is TMD treated?

There are many effective and simple treatments although thereis no one single cure. Studies have shown that up to 90% of allpatients will get better with some self-care, exercises and theuse of a splint (bite guard) to reduce the tension in the musclesaround the face. Occasionally other forms of treatment can beof benefit, e.g. physiotherapy, adjustment of the biting surfacesof the teeth or a course of medication. Only very rarely isorthodontics or surgery indicated for the treatment of TMD.

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What can you do?

You are the key - without your help the treatment will not be aseffective.

• Keep your teeth apart. Do this when you are not wearingyour splint. The proper resting position for your jaw is withthe teeth slightly apart and your lips gently together. Thisallows your jaw joints and muscles time to rest and heal. Yourteeth should only touch during chewing, swallowing andsometimes speaking.

• Avoid opening your mouth very wide.

• Avoid habits like chewing fingernails or gum.

• Avoid straining your neck and shoulders by poor posture. Thiscan occur when working at a computer or holding the phonebetween your neck and shoulder for a long time.

• Eat nutritious meals that do not require hard or prolongedchewing. A soft diet is particularly useful when symptoms ofTMD are more intense.

• Avoid caffeine and smoking. Both of these are stimulantswhich excite the nerves of your body. If you are having pain,any stimulants can make the pain seem worse and increasemuscle fatigue.

• Painkillers you would normally take for a headache, forexample paracetamol or ibuprofen can be taken for shortperiods if the pain is particularly intense.

• Follow your personal treatment programme. This will bedeveloped specifically for your needs by a dentist in the clinic.

• Try to give yourself 10-15 minutes each day to relax.

Remember - be patient - nine out of ten TMD patients will getbetter by simple methods alone.

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Exercise programme to relieve TMD

Please read carefully

• Always do the following exercises slowly and gently, relaxingthe muscles as much as possible.

• All movement must be slow, relaxed and pain-free.

• To be effective, these exercises must be performed regularly.

• If the exercises seem to be improving your jaw problem theycan be carried out more often.

• Most patients benefit by doing jaw exercises but if theyappear to make your jaw problem worse, stop doing them.

• Your dentist may prescribe other exercises depending on yourspecific need.

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Exercise 1

This exercise is designed to help you learn a smooth andprotective jaw opening pattern. It should be carried out in frontof a mirror and an ideal time is just after you have brushed yourteeth in the morning and evening. The jaw joint acts like a hingeand during this exercise you should only feel a rotation in thejoints as your jaw opens. Make sure you watch in the mirrorchecking that your jaw opens and closes in a straight vertical lineavoiding any sideways movement.

1. Working in front of a mirror, place your fingers over your jawjoints.

2. Curl your tongue backwards to the roof of your mouth.

3. Keeping your tongue in this position, open your mouth slowlyand smoothly.

4. Make sure your jaw opens in a straight line avoiding anysideways deviation.

5. Repeat this 5 times twice a day

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Exercise 2

This exercise strengthens the muscles that control jawmovement. This exercise can be carried out when you arerelaxing, a good time is whilst watching TV in the evening.

Starting positionStart with your jaw in its comfortable rest position with yourteeth slightly apart.

Exercise descriptionWhilst opening your mouth, use your hand to balance thepressure of your jaw. Hold for the count of 5 seconds.

Repeat 5 times each day.

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Further Information

If you have any problems or require further information, pleasetelephone 0191 2325131 and ask the switchboard to transferyou to the Restorative Dentistry Department, Dental Hospital,(between 9.00 am - 5.00 pm). At all other times, please contactyour own Dentist.

Information produced by Margaret Corson and Dr R Wassell July 2009

Review date: July 2014

Printed by Potts NFH/2296

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